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January 23, 2020

Study of VQI Data Compares Long-term Outcomes of EVAR and Open Repair for Ruptured AAA

January 23, 2020—A study of data from the Vascular Quality Initiative (VQI) registry evaluated the short- and long-term outcomes of endovascular aneurysm repair (EVAR) and open surgical aneurysm repair (OAR) for ruptured infrarenal abdominal aortic aneurysms (rAAAs). Mario D’Oria, MD, et al published the study’s findings online ahead of print in European Journal of Vascular and Endovascular Surgery (EJVES).

The background of the study is that although repair of rAAA has shifted from OAR to EVAR during the last decade, a comparison of long-term outcomes of the two modes has not been well described.

As summarized in EJVES, the investigators retrospectively analyzed the prospectively collected registry data to identify patients who underwent EVAR or OAR for rAAA from 2004 to 2018. The primary outcome was death (in hospital and overall postdischarge). Inverse probability weighting (IPW) was used to adjust for treatment selection. Poisson regression assessed the number of 1-year postdischarge reinterventions.

The investigators identified 4,257 patients who underwent EVAR (n = 2,389 [56%]) or OAR (n = 1868 [44%]) for rAAA. Patients were predominantly male (n = 3,310 [77.8%]) with a mean ± standard deviation age of 72.7 ± 9.6 years. A majority of patients (n = 2,449 [59.4%]) presented with hemodynamic instability. From 2004 to 2018, the use of EVAR for rAAA treatment increased from 7.8% to 67.2%.

In EJVES, the investigators reported the following:

  • After IPW, OAR was associated with higher odds of in-hospital mortality (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.54–2.01; P < .001). This was confirmed after multivariable logistic regression (OR, 2.08; 95% CI, 1.76–2.45; P < .001).
  • Multivariable Cox proportional hazards showed that OAR was also associated with increased overall postdischarge mortality among all patients (hazard ratio, 1.36; 95% CI, 1.23–1.51; P < .001).
  • Within weighted treatment groups, 5-year survival was significantly different (55% for EVAR vs 46% for OAR; P < .001).
  • OAR showed a significantly higher risk of 1-year postdischarge reinterventions (incidence rate ratio, 2.10; 95% CI, 1.52–2.89; P < .001).

The study’s conclusion is that within the VQI, EVAR for rAAA repair has been increasingly adopted with favorable short-term outcomes in terms of morbidity and mortality as compared with OAR. Unlike elective AAA repair, survival rates between EVAR and OAR do not converge in long-term follow-up for patients who survived the index hospitalization, noted the investigators in EJVES.

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